Less Postoperative Restrictions Following Total Hip Arthroplasty With Use of a Posterolateral Approach: A Prospective, Randomized, Noninferiority Trial

Traditionally, patients undergoing total hip arthroplasty (THA) have been advised to avoid certain movements that would put them at risk for dislocation. This has been of particular concern with the posterolateral, which has historically been associated with the highest dislocation rates. In recent years, however, improvements in surgical technique and implants (e.g. larger heads) have dramatically reduced dislocation rates. Thus, it is unclear if hip precautions are still necessary. The authors randomized 408 patients to standard care and patients who still had hip precautions while awake, but had no restrictions on sleeping position. Primary outcome was dislocation at 8 weeks, secondary outcomes were deep infection, pulmonary embolism, deep vein thrombosis, pain, function, and health-related quality of life. There were no significant differences on any outcomes between the two groups. The trial was designed as a non-inferiority trial, and found that not assigning sleeping precautions was indeed non-inferior to standard care.